Who is most at risk of severe COVID-19 or dying from COVID-19?
Answer: People over 60 (with risk substantially increasing in the very old) and those with underlying health issues such as obesity, diabetes, cardiovascular disease, and hematological cancer. People who have reduced or absent immunity to COVID-19, either because they are unvaccinated or because the vaccine has not been effective, are also at increased risk (compared to those who have developed immunity). Biologically, inborn errors of type I interferon pathway or having neutralizing anti-interferon autoantibodies increases the risk of severe COVID-19; however, these biomarkers are not used clinically. Psoriasis itself does not appear to be a major driver of poor COVID-19 outcomes.
What is the impact of systemic psoriasis treatments on COVID-19 outcomes?
Answer: Evidence to date suggests that most systemic therapies used for psoriasis do not meaningfully impact the risk of severe COVID-19. Prednisone, particularly when used in high doses, is associated with an increased risk of severe COVID-19 outcomes, and generally should be avoided, if possible, for the management of psoriatic disease. If prednisone is required for psoriatic arthritis, use the lowest dose needed to control symptoms.
What is the impact of psoriasis systemic treatments on the effectiveness of COVID-19 vaccines?
Answer: Treatments for psoriasis do not appear to meaningfully impact the clinical benefits of COVID-19 vaccines. This includes protection against severe COVID-19 in people with psoriasis who received vaccination while on systemic immunodulatory therapy. This observation is based primarily on data in people who received mRNA-based COVID-19 vaccines. Immunogenicity studies do, however, indicate that methotrexate, JAK inhibitors, and biologics may impact serologic (antibody) and/or cellular (T cell) responses to mRNA COVID19 vaccines. Holding methotrexate for 2 weeks after receiving an mRNA COVID19 vaccine may improve serologic (antibody level) response, although the impact on vaccine clinical effectiveness is unknown.
Who should get vaccinated for COVID-19?
Answer: The goal of COVID-19 vaccination is to reduce the risk of severe COVID-19, including hospitalization and death. Many different COVID-19 vaccines are now licensed, are highly effective in preventing severe COVID-19, and have prevented millions of COVID-19 deaths worldwide. In general, people living with psoriasis should get a primary vaccination regimen against COVID-19. Protection from severe COVID-19 outcomes may reduce somewhat over time. Booster vaccines to maintain immunity may be necessary, especially in those who received primary vaccination while on immunomodulating therapies and / or those at high risk for severe COVID-19 outcomes. Serious side effects from COVID-19 vaccines are very rare (<1 in every 10,000 people). There have been some reports of new onset or exacerbation of psoriasis and/or psoriatic arthritis in people receiving COVID-19 vaccines; however, these reports are uncommon, and a causal relationship has not been established.
Who should receive specific treatment for COVID-19 in the outpatient setting?
Answer: Several antiviral drugs are licensed for patients with mild-moderate COVID-19 at high risk of progressing to severe disease in many countries. Treatment for COVID-19 needs to be administered within days of the onset of symptoms to be effective. Drug choice, depending on patients’ immune status and underlying comorbidities or treatments, and prioritization of treatments vary by region and may change over time.
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